Over recent years, anti-TNFalpha have been used to treat rheumatoid arthritis. The principal secondary effect of anti-TNFalpha is tuberculosis infections. Another paradoxical effect, previously less well ... [more ▼]

Over recent years, anti-TNFalpha have been used to treat rheumatoid arthritis. The principal secondary effect of anti-TNFalpha is tuberculosis infections. Another paradoxical effect, previously less well understood, is the development of sarcoid-like granulomatous reactions. We report the case of a 36 year old woman who had been treated for 9 years with anti-TNF alpha. She developed a pulmonary sarcoid-like gra-nulomatosis, complication that is rare but not exceptional in patients treated with TNF-blockers. Discontinuation of anti TNF usually led to recovery. It has been suggested that these reactions mainly occur with etanercept, but this requires further confirmation. [less ▲]

INTRODUCTION: The evidence on the effectiveness of rehabilitation in lung cancer patients is limited. Whole body vibration (WBV) has been proposed as an alternative to conventional resistance training ... [more ▼]

INTRODUCTION: The evidence on the effectiveness of rehabilitation in lung cancer patients is limited. Whole body vibration (WBV) has been proposed as an alternative to conventional resistance training (CRT). METHODS: We investigated the effect of radical treatment (RT) and of two rehabilitation programmes in lung cancer patients. The primary endpoint was a change in 6-min walking distance (6MWD) after rehabilitation. Patients were randomised after RT to either CRT, WBVT or standard follow-up (CON). Patients were evaluated before, after RT and after 12 weeks of intervention. RESULTS: Of 121 included patients, 70 were randomised to either CON (24), CRT (24) or WBVT (22). After RT, 6MWD decreased with a mean of 38m (95% CI 22-54) and increased with a mean of 95m (95% CI 58-132) in CRT (p<0.0001), 37m (95% CI -1-76) in WBVT (p=0.06) and 1m (95% CI -34-36) in CON (p=0.95), respectively. Surgical treatment, magnitude of decrease in 6MWD by RT and allocation to either CRT or WBVT were prognostic for reaching the minimally clinically important difference of 54m increase in 6MWD after intervention. CONCLUSIONS: RT of lung cancer significantly impairs patients' exercise capacity. CRT significantly improves and restores functional exercise capacity, whereas WBVT does not fully substitute for CRT. [less ▲]

Patients undergoing hematopoietic stem cell transplantation (HSCT) display an airway neutrophilic inflammation before the transplantation that persists over the years. In this study, we have investigated ... [more ▼]

Patients undergoing hematopoietic stem cell transplantation (HSCT) display an airway neutrophilic inflammation before the transplantation that persists over the years. In this study, we have investigated the cytokine profile over a period of one year in sputum supernatant of patients who underwent HSCT. We have measured sputum supernatant levels of TNF-α, TGF-β1, IL-4, IL-5, IL-6, IL-8, IL-10, IL-13, IL-17, and IFN-γ in 49 HSCT patients and compared the results with those found in 40 COPD and 54 healthy subjects matched for age. Compared to healthy subjects, before the transplantation, HSCT patients exhibited raised levels of IL-6 (p<0.001) and IL-8 (p<0.05) while the other cytokines were generally poorly detectable. This picture was rather similar to what is seen in COPD even if cytokine levels were much greater in the latter with IL-8 being significantly greater in COPD than in HSCT patients (p<0.0001). In the 1 year following the transplantation, sputum IL-6 and IL-8 did not differ any longer compared to healthy subjects. Overall in HSCT patients, sputum IL-8 and IL-6 correlated with sputum neutrophil counts (r=0.4, p<0.0001; r=0.42, p<0.0001, respectively). In conclusion, sputum IL-6 and IL-8 may play a role in neutrophilic airway inflammation seen in patients undergoing HSCT. [less ▲]

BACKGROUND: Neutrophils have been involved in the pathogenesis of chronic obstructive pulmonary disease (COPD). Underlying mechanisms of neutrophil accumulation in the airways of stable and exacerbated ... [more ▼]

BACKGROUND: Neutrophils have been involved in the pathogenesis of chronic obstructive pulmonary disease (COPD). Underlying mechanisms of neutrophil accumulation in the airways of stable and exacerbated COPD patients are poorly understood. The aim of this study was to assess exhaled breath condensate (EBC) neutrophil chemotactic activity, the level of two chemoattractants for neutrophils (GRO-alpha and LTB4) during the course of an acute exacerbation of COPD (AECOPD). METHODS: 50 ex smoking COPD patients (33 with acute exacerbation and 17 in stable disease) and 20 matched ex smoking healthy controls were compared. EBC was collected by using a commercially available condenser (EcoScreen(R)). EBC neutrophil chemotactic activity (NCA) was assessed by using Boyden microchambers. Chemotactic index (CI) was used to evaluate cell migration. LTB4 and GROalpha levels were measured by a specific enzyme immunoassay in EBC. RESULTS: Stable COPD and outpatients with AECOPD, but not hospitalized with AECOPD, had raised EBC NCA compared to healthy subjects (p < 0.05 and p < 0.01 respectively). In outpatients with AECOPD EBC NCA significantly decreased 6 weeks after the exacerbation. Overall EBC NCA was weakly correlated with sputum neutrophil counts (r = 0.26, p < 0.05). CONCLUSIONS: EBC NCA rose during acute exacerbation of COPD in ambulatory patients and decreased at recovery. While LTB4 seems to play a role both in stable and in exacerbated phase of the disease, the role of GRO-alpha as a chemotactic factor during AECOPD is not clearly established and needs further investigation. [less ▲]

in International journal of chronic obstructive pulmonary disease (2014), 9

Chronic obstructive pulmonary disease (COPD) is an obstructive and progressive airway disease associated with an important reduction in daily physical activity and psychological problems that contribute ... [more ▼]

Chronic obstructive pulmonary disease (COPD) is an obstructive and progressive airway disease associated with an important reduction in daily physical activity and psychological problems that contribute to the patient's disability and poor health-related quality of life (HRQoL). Nowadays, pulmonary rehabilitation (PR) plays an essential role in the management of symptomatic patients with COPD, by breaking the vicious circle of dyspnea-decreased activity-deconditioning-isolation. Indeed the main benefits of comprehensive PR programs for patients with COPD include a decrease in symptoms (dyspnea and fatigue), improvements in exercise tolerance and HRQoL, reduction of health care utilization (particularly bed-days), as well as an increase in physical activity. Several randomized studies and meta-analyses greatly established the benefits of PR, which additionally, is recommended in a number of influential guidelines. This review aimed to highlight the impact of PR on COPD patients, focusing on the clinical usefulness of PR, which provides patients a good support for change. [less ▲]

Objective: To assess the outcomes of a 6-month comprehensive multidisciplinary outpatient pulmonary rehabilitation programme in patients with chronic obstructive pulmonary disease according to age. Design: Prospective cohort study. Patients: A total of 140 patients with chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease (GOLD) 3-4) admitted to our centre for pulmonary rehabilitation. Methods: Patients were divided into 3 groups: group A (< 65 years), group B (65-74 years) and group C (>/= 75 years). All the patients received an education and individualized training programme. Pulmonary rehabilitation efficacy was evaluated at 6 months of treatment and 12 months post-treatment. Results: A total of 116 patients completed the pulmonary rehabilitation programme: 59 in group A (85.5%), 40 in group B (80%) and 17 in group C (80.9%). All the parameters studied (number of sessions, 6-min walking distance, isometric quadriceps strength, health-related quality of life, maximal load, peak oxygen uptake, maximal inspiratory and expiratory pressures) were significantly improved in each of the groups at 3 and 6 months compared with baseline. Moreover, percentage changes from baseline at 6 months for all of the parameters studied were not significantly different between age-groups. Conclusion: Pulmonary rehabilitation is efficient in elderly patients with severe and very severe chronic obstructive pulmonary disease, and their compliance with pulmonary rehabilitation was similar to that seen in younger groups. Therefore, elderly patients with chronic obstructive pulmonary disease should not be denied pulmonary rehabilitation. [less ▲]

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a chronic airway inflammatory disease caused by repeated exposure to noxious gases or particles. It is now recognized that the disease also ... [more ▼]

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a chronic airway inflammatory disease caused by repeated exposure to noxious gases or particles. It is now recognized that the disease also features systemic inflammation. The purpose of our study was to compare airway and systemic inflammation in COPD to that seen in healthy subjects and to relate the inflammation with the disease severity. METHODS: Ninety-five COPD patients, encompassing the whole severity spectrum of the disease, were recruited from our outpatient clinic and rehabilitation center and compared to 33 healthy subjects. Induced sputum and blood samples were obtained for measurement of inflammatory cell count. Interleukin (IL)-4, IL-6, IL-10, TNF-alpha and IFN-gamma produced by 24h sputum and blood cell cultures were measured. RESULTS: Compared to healthy subjects, COPD exhibited a prominent airway neutrophilic inflammation associated with a marked IL-10, IL-6 and TNF-alpha release deficiency that contrasted with a raised IFN-gamma production. Neutrophilic inflammation was also prominent at blood level together with raised production of IFN-gamma, IL-10 and TNF-alpha. Furthermore, sputum neutrophilia correlated with disease severity assessed by GOLD stages. Likewise the extent of TNF-alpha release from blood cells also positively correlated with the disease severity but negatively with that of sputum cell culture. Blood release of TNF-alpha and IL-6 negatively correlated with body mass index. Altogether, our results showed a significant relationship between cellular marker in blood and sputum but poor relationship between local and systemic release of cytokines. CONCLUSIONS: COPD is characterized by prominent neutrophilic inflammation and raised IFN-gamma production at both bronchial and systemic level. Overproduction of TNF-alpha at systemic level correlates with disease severity and inversely with body mass index. [less ▲]

Lung transplantation is an established treatment of pulmonary diseases at an advanced stage. The purpose of our study is to present the benefits, indications and complications of this surgical procedure ... [more ▼]

Lung transplantation is an established treatment of pulmonary diseases at an advanced stage. The purpose of our study is to present the benefits, indications and complications of this surgical procedure in the CHU of Liege. The cohort includes 14 patients transplanted between 2005 and 2009, and who were inserted in a pulmonary rehabilitation programme at the university hospital of Liege. The criteria of assessment are the values of respiratory function tests at rest and exercise, and quality of life. Inherent complications related to this type of surgical operation have been collected. We found a dramatic improvement in pulmonary function tests performed at rest both immediately after the transplantation and after 6 months. Likewise exercise capacity was already increased shortly after the transplantation and further improved 6 months later. As for health related quality of life, parameters that improved the most were dyspnoea and global quality of life, and the improvement was already maximal immediately after the transplantation. Our retrospective study confirms the data of the literature, namely an improvement of respiratory function, effort capacity and quality of life after lung transplantation. [less ▲]

Mediastin pathology includes primary lesion and lymph node invasion. The exploration of this anatomical region remains difficult and even hazardous, particularly to obtain histological biopsies. No ... [more ▼]

Mediastin pathology includes primary lesion and lymph node invasion. The exploration of this anatomical region remains difficult and even hazardous, particularly to obtain histological biopsies. No invasive diagnostic exploration (thorax tomodensitometry and positron emission tomography) allows a histological precision, so mediastinoscopy remains the gold standard in the mediastinum investigation. However, it is not deprived of risk. Recently, guided biopsies and real-time transbronchial needle aspiration by endobronchial ultrasonography (EBUS) have been shown to increase the diagnostic yield over conventional bronchoscopic techniques. Therefore, EBUS is a suitable alternative to mediastinoscopy in the diagnosis of pulmonary or extra-thoracic malignancy, in the staging of mediastinal lymphadenopathy, and in the evaluation of mediastinal response after induction therapy. In the present paper, we present this new diagnostic approach and clarify the current indications of EBUS. [less ▲]

Background Neutrophils have been implicated in the pathogenesis of COPD. Several chemoattractants for neutrophils have been measured in exhaled breath condensate (EBC) and induced-sputum (IS) from ... [more ▼]

Background Neutrophils have been implicated in the pathogenesis of COPD. Several chemoattractants for neutrophils have been measured in exhaled breath condensate (EBC) and induced-sputum (IS) from patients with COPD. Objectives The aims of this study were to compare EBC and IS supernatant neutrophil chemotactic activity from ex-smoking COPD and healthy ex-smokers, and to assess the contribution of LTB(4) to this activity. Methods 34 COPD were compared to 24 controls. EBC and IS chemotactic activity for neutrophils were assessed by using Boyden microchambers. Chemotactic index (CI) was used to evaluate cell migration. LTB(4) was measured by a specific enzyme immunoassay. Contribution of LTB4 to EBC and sputum neutrophil chemotaxis was assessed by an LTB(4) receptor antagonist (U-75302: Cayman Chemical Company, Ann Arbor, MI, USA). Results EBC and IS from both COPD and healthy subjects displayed significant neutrophil chemotactic activity but this activity was raised in COPD compared to healthy subjects. Chemotactic activity contained in sputum, however, failed to correlate with that in EBC. In COPD there was a significant correlation between EBC neutrophil chemotactic activity and sputum neutrophil counts. LTB(4) levels were raised in EBC, but not in sputum, from COPD as compared to healthy subjects. LTB(4) receptor antagonist (2.5 10(-4) M) reduced by 44.6% and by 44.4% chemotactic activity contained in EBC and sputum respectively. Conclusions EBC and IS from COPD patients have a raised neutrophil chemotactic activity to which LTB4 contributes. [less ▲]

Pleural involvements are common and various respiratory diseases including inflammatory, infectious, occupational, or neoplastic pathological entities...Pleural thickening and pleurisy are usual ... [more ▼]

Pleural involvements are common and various respiratory diseases including inflammatory, infectious, occupational, or neoplastic pathological entities...Pleural thickening and pleurisy are usual radiological presentation. Etiological diagnosis imposes a vast and sometimes difficult exploration and it, especially since the conventional imaging by radiology, ultrasound, scanning and nuclear magnetic resonance has no specific diagnostic criteria for pleural malignancy. The metabolic imaging by positron emission tomography (PET) has been gradually positioned in the decision-making algorithm exploration of the pleural disease due to its excellent sensitivity in the diagnosis of malignant pleurisy (88.8%-100%). The analysis of chemistry, bacteriology and cytology pleural fluid makes a significant contribution to the diagnostic approach. However, although inescapable, thoracocentesis has a diagnostic sensibility not exceeding 62%. Moreover, the sensibility of the pleural blind needle biopsies does not exceed 51%. So, thoracoscopy, more invasive, is often justified to precise pleural disease with a diagnostic sensitivity greater than 95%. Finally, despite the diagnostic arsenal available, over 10% of pleurisies remain unknown etiology. [less ▲]

The current treatment of chronic obstructive pulmonary disease (COPD) patients must comprise, in addition to an optimal pharmacological treatment, a pulmonary rehabilitation, if possible multidisciplinary ... [more ▼]

The current treatment of chronic obstructive pulmonary disease (COPD) patients must comprise, in addition to an optimal pharmacological treatment, a pulmonary rehabilitation, if possible multidisciplinary, and a program of post-rehabilitation in order to maintain the outcomes. Today pulmonary rehabilitation has proved to be effective in improving dyspnoea, exercise capacity and quality of life in COPD patients, and reducing the use of health services and thus the cost. In this article we want to present pulmonary rehabilitation, its indications and results, and the way by which it is held in the CHU of Liege. [less ▲]

BACKGROUND: The intensity of the [F]fluorodeoxyglucose (F-FDG) uptake is an independent prognostic indicator in non-small cell lung cancer (NSCLC). We evaluate the relationship between the metabolic ... [more ▼]

BACKGROUND: The intensity of the [F]fluorodeoxyglucose (F-FDG) uptake is an independent prognostic indicator in non-small cell lung cancer (NSCLC). We evaluate the relationship between the metabolic activity of the primary and the pleurisy in T4 NSCLC. METHODS: 25 patients (16 males, nine females, mean age 63 years, performance status 1) with pathology-proven, T4 NSCLC and malignant pleurisy were included. All were treated by a platinum salt-based chemotherapy regimen. Positron emission tomography (F-FDG-PET) was performed before treatment, according to a routine procedure. Regions of interest were placed over the primary and the pleural effusion on the transaxial slice showing the highest activity. The maximum pixel standard uptake values (SUVs) were calculated. Overall survival was determined by standard Kaplan-Meier survival analysis. All patients were followed up until death. RESULTS: The median survival for the entire population was 83 days (7-988). The SUVs were higher in the primary than in the pleurisy (9.2+/-5.6 and 5.5+/-2.2, respectively). There was no correlation between primary and pleurisy SUVs (r=0.3, P>0.05). The metabolic activity of the primary tumor did not predict the outcome: the median survival was 77.5 days (range 7-988) and 87 days (19-454) in the groups with SUVs lower and higher than the median value (8.7), respectively (P>0.05). By contrast, the metabolic activity of the pleurisy was significantly correlated with the median survival, which was 196 days (40-988) when the SUVs were lower than the median value (5) and 74 days (7-170) when they were higher (P=0.0096). CONCLUSION: Among patients with T4 NSCLC, those with high metabolic activity in the pleural effusion have a dire prognosis, whereas the metabolic activity of the primary fails to predict the survival. [less ▲]

Exacerbations of chronic obstructive pulmonary disease (COPD) play a very important role. Unfortunately they were neglected a long time in the therapeutic tests. However exacerbations influence the ... [more ▼]

Exacerbations of chronic obstructive pulmonary disease (COPD) play a very important role. Unfortunately they were neglected a long time in the therapeutic tests. However exacerbations influence the decline of the respiratory function over time, cause important deterioration of the quality of life of the patients, increase morbidity and mortality of COPD, and finally represent a burden for health care. Reducing the number of exacerbations could potentially slow down the progression of the disease. Thus the prevention of exacerbations should be the "corner stone" of the maintenance treatment of the COPD. In this review we propose to recall the importance of exacerbations in COPD and to present the treatment which have been shown to reduce exacerbation rate in COPD. [less ▲]